Annest Nicole M, VanBeek Marta J, Arpey Christopher J, Whitaker Duane C
Division of Mohs Surgery, Scripps Clinic and Research Institute, La Jolla, California 92037, USA.
J Am Acad Dermatol. 2007 Jun;56(6):989-93. doi: 10.1016/j.jaad.2006.12.017.
Intralesional methotrexate (MTX) is an effective treatment for keratoacanthoma (KA).
We sought to systematically examine response rates and adverse events in KA treated with intralesional MTX.
All cases of KA treated with intralesional MTX at our institution from 1991 to 2006 were identified. A MEDLINE and PubMed search of cases of KA treated with intralesional MTX was also performed.
In all, 38 cases of KA treated with intralesional MTX were identified: 18 from our institution and 20 from the literature. Intralesional MTX achieved resolution in 92%, requiring an average of 2.1 injections an average of 18 days apart. Adverse events were rare, with two reports of pancytopenia in patients with chronic renal failure.
Use of single case reports, small series, and retrospective analysis are limitations.
Intralesional MTX is a useful nonsurgical therapy for the treatment of KA. Histologic diagnosis before initiation of treatment is preferred. A complete blood cell count at baseline and during treatment should be considered to monitor for potential cytopenia.
病灶内注射甲氨蝶呤（MTX）是治疗角化棘皮瘤（KA）的一种有效方法。
我们试图系统地研究病灶内注射MTX治疗KA的有效率和不良事件。
确定了1991年至2006年在我们机构接受病灶内注射MTX治疗的所有KA病例。还对MEDLINE和PubMed上病灶内注射MTX治疗KA的病例进行了检索。
总共确定了38例接受病灶内注射MTX治疗的KA病例：18例来自我们机构，20例来自文献。病灶内注射MTX的治愈率为92%，平均需要注射2.1次，平均间隔18天。不良事件罕见，有两例慢性肾衰竭患者出现全血细胞减少的报告。
使用单病例报告、小样本系列研究和回顾性分析是其局限性。
病灶内注射MTX是治疗KA的一种有用的非手术疗法。治疗开始前最好进行组织学诊断。应考虑在基线和治疗期间进行全血细胞计数，以监测潜在的血细胞减少情况。
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